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Biomedical subjects

K Kettunen

Publications and source records attributed to K Kettunen.

At least 19 recordsLinked to original sources
PubMed1994

Maternal drug treatment and human milk banking.

We studied prospectively during one year temporary drug use by mothers donating breast milk to assess the problem of drug treatment of donors. Sixty-four of the 284 mothers (22.5%) had to abstain from donating due to medication. The indication was infection in 50/56 treatments (89.3%). Antimicrobial agents were prescribed 44/52 times (84.6%). The channelling of milk from mothers in early phases of lactation to premature and newborn infants was identified as a special risk situation, if mothers on medication are not excluded. The limited number of such donors leads to use of milk unpooled or pooled to small volumes with increased risk for adverse effects to babies as a consequence. We recommend a wash-out period of 5 half-lives of the drug after the last ingested dose. For the majority of drugs in this study, with some important exceptions, a wash-out period of 1 day was sufficient.

Adult↗
PubMed1993

Prevalence of familial hypercholesterolemia among young north Karelian patients with coronary heart disease: a study based on diagnosis by polymerase chain reaction.

Two deletions of the low density lipoprotein (LDL) receptor gene account for about 90% of the mutations that cause familial hypercholesterolemia (FH) in eastern Finland. The FH-Helsinki mutation deletes exons 16, 17 and a portion of exon 18, while the FH-North Karelia allele is characterized by a deletion of seven nucleotides from exon 6 of the LDL receptor gene. We developed a DNA assay based on the use of polymerase chain reaction (PCR) which simultaneously detects both of these mutations. We have screened 90 young (< 45 years) eastern Finns with symptomatic coronary heart disease (CHD) for the presence of these FH genes. One or the other of the mutations was present in 4 out of 55 survivors of acute myocardial infarction (AMI) and 4 out of 35 patients with angina pectoris (AP), but in none of 50 healthy controls of similar age. These data show a relatively high prevalence of confirmed FH in young CHD patients (AMI and MI combined: 8/90, or 9%), and also demonstrate the feasibility of PCR techniques in diagnosis of FH among populations with enrichment of specific types of LDL receptor gene mutations.

Adult↗
PubMed1991

Thromboprophylaxis in patients with hip fractures: a prospective, randomized, comparative study between Org 10172 and dextran 70.

A prospective, randomized, assessor-blind trial has been undertaken to compare the thromboprophylactic effect and safety of the heparinoid Org 10172 (a mixture of low molecular-weight sulfated glycosaminoglycuronides) and dextran 70 in patients operated on for hip fracture. Prestudy biostatistical calculations led to the need for 260 patients. Three hundred eight patients were randomized and 19 were excluded after randomization, the majority because of postponed surgery. Analyses were made on the 289 patients on an intention-to-treat basis, as well as on the 247 patients given correct prophylaxis. Diagnosis of deep vein thrombosis was based on bilateral ascending phlebography on postoperative days 10 through 12. The frequency of deep vein thrombosis on an intention-to-treat basis was 10% in the Org 10172 group and 30% in the dextran 70 group and, on the basis of correct prophylaxis, 12% and 31%, respectively, both differences being significant (p less than 0.001). Two-month mortality rates were equal in the groups. Three fatal pulmonary emboli were seen in the dextran group. Significantly more patients in the dextran group received postoperative transfusions; no other differences in various hemorrhagic parameters were seen. Thus it can be concluded that Org 10172 has a significantly better thromboprophylactic effect than does dextran in patients with hip fractures without significant side effects.

Aged↗
PubMed1990

The use of fibrinogen uptake test in screening for deep vein thrombosis in patients with hip fracture.

255 hip fracture patients were studied by 125I-fibrinogen uptake test and bilateral phlebography. We found the sensitivity of fibrinogen scanning to be 44% for the non-operated limb and 50% for the calves. The predictive value of a negative result was found to be 92% and 93% respectively. We conclude that the use of fibrinogen uptake test as single diagnosticum is not valid and can only be recommended in combination with phlebography when studying patient where the frequency of DVT is expected to be low.

Fibrinogen↗
PubMed1990

An improved prognostic index of axillary node involvement in breast cancer incorporating DNA ploidy and tumour size.

A multivariate prognostic index based on clinical data and the results of flow cytometry for the grading of breast cancer was evaluated in 117 patients whose disease had been detected and treated by mastectomy with axillary clearance between 1974 and 1976. Survival analysis with Cox's regression model pointed to three important prognostic factors: lymph node involvement (p less than 0.001), DNA ploidy (p less than 0.01) and tumour size (p less than 0.01). These factors were incorporated into a prognostic index, in which the lymph node involvement, DNA ploidy, and tumour size contributed to the index in that order. Logistic discriminant analysis with five year follow-up as the fixed end point (70 alive, 47 dead) gave the same result; lymph node involvement, tumour size, and DNA ploidy were the best prognostic indicators of survival. The result showed that our multivariate prognostic index was more powerful than lymph node involvement alone. The use of this prognostic index is recommended for selecting patients for different treatments.

Adult↗
PubMed1989

Relationship between DNA ploidy and survival in patients with primary breast cancer.

The DNA ploidy of breast cancer tissue from paraffin blocks was measured by flow cytometry in 117 patients whose disease had been detected and treated with surgery between 1974 and 1976. Patients with aneuploid tumours had positive axillary nodes and distant metastases more often than those with diploid tumours. Aneuploid tumours were more common in postmenopausal than premenopausal women. The S-phase fraction (SPF) was significantly higher in aneuploid than in diploid tumours and positive axillary lymph nodes were found in 26 per cent of the patients who had a tumour with a SPF below the median (4.8 per cent) and in 48 per cent of those with tumours with SPF values above the median. At the primary clinical investigation 2 per cent of the patients with diploid tumours and 6 per cent of those with aneuploid tumours had distant metastases. During the follow-up, the proportion of patients with distant metastases increased to 42 and 72 per cent, respectively. With a follow-up of 11.5 years, the DNA aneuploidy of the tumour showed a significant association with decreased survival. Thirty-three per cent of patients with diploid and 65 per cent of patients with aneuploid tumours had died from breast cancer during the follow-up (P less than 0.001). All patients with hypertetraploid or multiploid tumours died from breast cancer. High SPF values were associated more closely with distant metastases or death during the follow-up than low SPF values. Our results suggest that DNA ploidy measured by flow cytometry from paraffin embedded tissue blocks of human breast cancer can be used to predict the aggressiveness of the tumour and the survival of the patients.

Aged↗
PubMed1989

Iatrogenic compartment syndrome, A follow-up of four cases caused by elastic bandage.

We describe four patients suffering from lower limb compartment syndromes which were caused by constrictive bandages applied after stripping of varices. The dressing was erroneously only partially removed, when the patients started complaining of severe pain and tension in the operated legs. The damages varied from extended irreversible neuromuscular defects to lesser functional handicaps. Three patients had corrective surgery. The clinical follow up over several years showed little improvement, secondary complaints were frequent.

Adult↗
PubMed1988

Diet, serum, breast fluid growth hormone, and prolactin levels in normal premenopausal Finnish and American women.

A food frequency questionnaire was used to estimate and compare the dietary fat and fiber consumption of 94 premenopausal women in Kuopio (rural Finland, where there is a relatively low risk of breast cancer) and 61 American women in New York (where there is a high risk of breast cancer). In keeping with previous reports concerning middle-aged men, both groups had high fat intakes, but the Finnish women had considerably higher fiber intakes (24 +/- 11 vs. 16 +/- 6 g). Serum and breast fluid growth hormone and prolactin levels were compared in 29 of these American women and 24 of the Finnish women. All were healthy and had regular menstrual cycles. Serum growth hormone levels, which were measured by radioimmunoassay, were higher in the Finnish women; all but three of their breast fluids contained detectable growth hormone, frequently at extremely high concentration. In contrast, only 2 of the 29 breast fluids from American women had detectable amounts of growth hormone. Of the Finnish samples, 10 were also measured by an immunoradiometric assay with high specificity for the 22,000-dalton growth hormone molecule; all but 3 had values less than 3.0 ng/ml. Serum and breast fluid prolactin concentrations, which were determined by radioimmunoassay, were no different in the two groups; both groups frequently had considerably higher levels in breast fluid compared with the corresponding serum.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Serum and breast duct fluid prolactin and estrogen levels in healthy Finnish and American women and patients with fibrocystic disease.

Nipple aspiration yielded measurable amounts of breast duct fluid for 27 of 42 (64%) healthy premenopausal Finnish women, 93 of 218 (43%) premenopausal American patients with fibrocystic disease, but only 24 of 92 (26%) healthy American premenopausal controls. When aspiration was successful, the average volumes obtained were larger for the normal Finnish women and, particularly, for the American fibrocystic disease patients compared with the American controls. The difference in secretion between the healthy Finnish and American women appeared to be related to a history of breast feeding, and its duration. While serum estrogen and prolactin concentrations were similar in the three groups, prolactin levels in breast fluids from the Finnish women were frequently higher than those in the American controls. A similar trend, which did not reach statistical significance, was observed in the 43 of 93 (46%) secretors with fibrocystic disease and cyclical mastalgia.

Adult↗
PubMed1985

The 125I-labelled fibrinogen uptake test in elective hip surgery.

The value of the 125I-labelled fibrinogen uptake test as a screening method for deep vein thrombosis was estimated in 49 patients (97 extremities) undergoing elective hip operations. The legs were monitored preoperatively, on the 1st, 2nd and 4th postoperative days. Contrast venography, as a reference method, was performed on the 5th postoperative day. The sensitivity was 73%, specificity 85%, positive predictive value 63%, negative predictive value 86% and correlation coefficient 55%. 78% of fibrinogen uptakes appeared within the first 24 hours, and 6% on the 4th postoperative day. Only 1 of 3 patients with a positive fibrinogen uptake test in the femoral region had roentgenologic evidence of deep vein thrombosis. According to these results the isotope-labelled fibrinogen uptake test can also be utilized as a screening method in elective hip surgery.

Fibrinogen↗
PubMed1984

A randomized study of a semisynthetic heparin analogue and heparin in prophylaxis of deep vein thrombosis.

The prophylactic effect of a semisynthetic heparin analogue (SSHA) on deep vein thrombosis was investigated in a prospective double-blind multicentre trial. 440 major general surgical and gynaecological patients were randomized to one of three treatment groups: 50 mg SSHA, 37.5 mg SSHA and 5000 units sodium heparin subcutaneously 12-hourly. Deep venous thrombosis (DVT) was diagnosed with the fibrinogen uptake test and verified with phlebography. Bleeding complications and other side-effects were carefully monitored. There were no significant differences between the three treatment groups of patients in age, sex, type of operation or risk factors. A DVT was diagnosed in 16 patients (12 per cent) in the SSHA 50 mg group, in 21 patients (15 per cent) in the SSHA 37.5 mg group and 21 patients (14 per cent) in the heparin-treated group. No significant differences were found in the number of patients who bled unexpectedly in the postoperative period, required transfusion or developed wound haematomas. Blood loss at operation was similar in all three groups. Three pulmonary emboli were diagnosed by pulmonary scintigraphy, one in each group.

Adult↗
PubMed1984

Screening for postoperative pulmonary embolism on the basis of clinical symptomatology, routine electrocardiography and plain chest radiography.

The incidence of pulmonary embolism (PE) and the usefulness of various screening methods for its detection were studied in 108 patients undergoing elective hip surgery. Twenty patients had PE as shown by perfusion-ventilation lung scintigraphy. Six of them had symptoms of embolism. Clinical symptoms of PE, highly suggestive electrocardiographic (ECG) signs and signs in chest radiographs showed high specificity but low sensitivity with regard to PE. If the non-specific ECG signs and the symptoms and signs of deep vein thrombosis in the calves had also been taken into account, it would have been possible to identify 95% of the patients with PE. The use of all these screening tests revealed a suspicion of PE in two thirds of the patients. The simplest way to screen for postoperative PE seems to be to use a combination of the symptoms and signs of both PE and deep vein thrombosis, and to identify any tachycardia. This method gave a sensitivity of 85%.

Electrocardiography↗
PubMed1983

Postoperative thromboembolism and risk factors in elective hip surgery.

The incidence of pulmonary embolism determined by perfusion - ventilation lung scintigraphy was 19% in 108 consecutive patients undergoing elective hip operations. Twelve patients had clinical symptoms. The sensitivity of clinical symptoms was 30 and the specificity 93%. Warfarin was used as prophylactic anticoagulant. The incidence of deep vein thrombosis examined by contrast venography was 43%. Only one patient developed femoral vein thrombosis propagating from the calf region. From the clinical risk factors, overweight had a statistically significant relationship to thromboembolism (p = 0.005). Age over 60 years was positively associated but the difference was not significant. When operation time exceeded 150 min the risk increased significantly (p less than 0.01). A large volume of blood loss at operation showed an increased but statistically insignificant trend towards thromboembolism. There were no fatal emboli. Although prophylactic warfarin treatment is not able to prevent the development of thromboembolism, it probably reduces the incidence of fatal pulmonary emboli. Of clinical and operative risk factors overweight and increasing operation time seem to have the strongest relationship to thromboembolism.

Adult↗
PubMed1983

Computed tomography of spinal and pelvic fractures.

The value of computed tomography (CT) compared with conventional x-ray was assessed in 29 spinal and 9 pelvic fractures. In the so called bursting fractures of spinal vertebrae the position of bone fragments in the neural canal was shown better by CT. The neural canal was remarkably narrowed on several occasions without the patient having any clinical symptoms of root or medullary compression. In 2 patients a fracture of laminae was discernible only on CT. Vertical fractures of vertebral bodies were also difficult to distinguish on the conventional plain x-ray. CT was helpful for planning of the anterolateral decompression operation of L2 in one patient. In cases of pelvic trauma sacro iliac joint diastasis was readily shown by CT. CT was clearly better able to determine whether the fracture extended across the sacro iliac joint. Also in fractures of the iliac wings CT readily showed the internal and external surfaces which were difficult to evaluate on plain radiographic examination. In spinal and pelvic fractures CT can give useful additional information which can influence the treatment of the trauma patient.

Fractures, Bone↗
PubMed1981

Breast secretion in Finnish women: a metabolic epidemiologic study.

Breast fluid was collected from 244 nonlactating Finnish women with no known breast disease and analyzed with respect to various epidemiologic and hormonal parameters commonly associated with breast cancer risk. The data obtained permit characterization of women with breast secretory ability and provide fundamental information on the hormone composition of breast fluid in a nondiseased population. No association was found between any epidemiologic variables (e.g., age, marital status, the number of pregnancies, the age of first pregnancy) and the ability to secrete a measurable amount of breast fluid. In addition, there appeared to be no correlation between prolactin and estrogen levels in serum and those in breast fluid within individual subjects. However, the median breast fluid prolactin level was approximately two-fold greater and the median breast fluid estrogen level was about six-fold greater than the corresponding serum values. It appears that breast ductal epithelial cells can actively transport both steroid and polypeptide hormones across a concentration barrier. Further metabolic epidemiologic investigations of hormones and potential carcinogens in the breast fluid from populations with high and low risks for breast cancer are suggested.

Adult↗
PubMed1980

A seasonal difference in serum 25-hydroxyvitamin D3 in a Finnish population.

A chromatographic assay procedure for the analysis of 25-hydroxyvitamin D3 [25(OH)D3] in human serum is described. The procedure involves methanol/chloroform extraction of serum lipids followed by separation of the vitamin D metabolites and purification from interfering contaminents by chromatography on Sephadex LH-20 and by high-pressure liquid chromatography. 25(OH)D3 is quantitated by uv detection, and its peak height compared with those of standards. Values in normal human serum samples taken in July-August and January-February are: 33.0 +/- 13.6 ng/ml (82.5 +/- 34.1 nmol/1) and 14.5 +/- 12.2 ng/ml (36.3 +/- 30.5 nmol/1) (means +/- SD), respectively (p less than 0.001). The summer values are somewhat lower in the elderly subjects as compared to younger ones, but a seasonal difference was observed in both groups. This difference may be due to a relatively low vitamin D intake and a limited sun exposure.

Adolescent↗